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of the pancreas removed and not remove the spleen. removing or not removing an oregon based on which door you walk into comedies are all good hospitals and good hospitals with good reputations. removing it colin. they're two different ways of doing it, minimally invasive and an open incision in some say you can do it either way. we have a "new england journal of medicine" study that's over 10 years older shows a minimally invasive is better and it's common sense that it's better but there is a the wild west of medicine that only half of the patients that need minimally invasive we'll ever have it done that way. >> host: you use the term the wild west of medicine and elsewhere in your book you talk about the need to have a new sheriff in town. so, talk to me a little bit about this concept of the new sheriff in town or a con ability or holding people responsible and how that balances with what we frequently hear when we try and move forward with standardization or accountability as an artform and medicine. out of those two things kind of play out? >> guest: i get the artform of medicine. most of th
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